The reciprocal dynamics of organizing and sense‐making in the implementation of major public‐sector reforms

Abstract: Drawing on a longitudinal study from the early years of implementation of health‐care networks in Quebec, this article describes how public‐sector managers deal with complex challenges when both organizational structures and organizational strategies are radically transformed simultaneously. The new organizations studied had to completely re‐shuffle roles and responsibilities of their management teams while making sense of their new mandate of developing a population‐focused approach to health problems – all the time maintaining day‐to‐day operations. The four health‐care networks studied proceeded somewhat differently to meet these reciprocal challenges. The study reveals the importance of balancing organizing initiatives (focused on structures) with “sense‐making” initiatives (focused on strategies), of developing capacities for sense‐making through the creation of key “sense‐maker/sense‐giver” positions whose occupants are able to ensure that conceptual activities engage people working at different levels, even as organizational structures are in flux, and of mobilizing external constraints and influences as opportunities and resources in sense‐making and organizing. Sommaire : Se fondant sur une étude longitudinale des premières années de la mise en œuvre des réseaux de soins de santé au Québec, cet article décrit la manière dont les gestionnaires du secteur public font face à des défis complexes, alors que les structures et les stratégies organisationnelles sont radicalement transformées simultanément. Les nouveaux organismes étudiés ont dû complètement remanier les rôles et les responsabilités de leurs équipes de gestion et comprendre leur nouveau mandat d'élaborer une approche axée sur la population pour ce qui est des problèmes de santé, tout en maintenant leurs activités au jour le jour. Les quatre réseaux de soins de santéétudiés ont travailléà relever ces défis réciproques d'une manière assez différente. L'étude révèle l'importance de trouver un équilibre entre les initiatives consistant à organiser (axées sur les structures) et les initiatives consistant à interpréter les faits (axées sur les stratégies) ; de perfectionner les capacités à interpréter les faits grâce à la création de postes clés d'«interpréteurs de faits», dont les titulaires veilleraient à ce que des activités conceptuelles fassent intervenir les gens travaillant à différents niveaux même lorsque les structures organisationnelles fluctuent continuellement; et enfin de tirer parti des contraintes et influences externes comme autant d'occasions et de ressources pour interpréter et organiser les faits.     

Evaluation and treatment of insanity acquittees in the community

This paper describes the monitored outpatient treatment program for Psychiatry Security Review Board (PSRB) clients in the largest single community treatment agency in the Oregon system. We describe 161 persons referred to this agency for evaluation and treatment. Ninety-one PSRB clients received treatment and of this group 51% had their conditional release revoked by the PSRB. The most frequent cause of revocation was noncompliance with treatment. There were only 11 crimes committed during the study period, four of which were in the felony range. The majority of PSRB clients are chronically mentally ill persons. We discuss both the treatment approach and our results in light of a recently published research agenda for insanity acquittees.     

Mobilising evidence in public policy: The contribution of the evidence provider

This article contributes to the conceptualisation of evidence‐based policy through providing a framework of the key factors that influence research utilisation, including those that shape the quality of evidence provided. We apply this framework to an analysis of public policy to regulate the remuneration of freight truck drivers to improve workplace safety in their industry. Recent policymaking concerning the regulation of truck drivers’ remuneration in Australia provides an opportunity to examine the quality and utilisation of research evidence by external evidence providers in opposing political contexts. This article suggests the need for informed and vigilant scrutiny of the contributions of evidence providers to government policymaking, particularly in the case of wicked policy problems about which there are sustained ideological differences that underpin problematisation, research interpretation, and conceivable policy solutions.     

The Changing Nature of Rationing in the UK National Health Service

This paper presents findings from empirical research exploring recent developments in healthcare rationing in the UK, and how far these were influenced by the National Health Service (NHS) internal market. Results suggest explicit rationing has continued to spread, but the focus has shifted from exclusions of whole treatments from NHS provision towards a reconciliation of implicit and explicit approaches. There is growing interest in explicit criteria to guide decision making, within which clinicians exercise discretion in indi-vidual cases. The market contributed to the growth in explicit rationing, notably by decoupling healthcare purchasers (health authorities and GP fundholders) and providers (hospital and community health services) from their previously shared responsibility to manage resources. However, other factors have been influential, especially concern to control rising expenditure. Having originally prompted more explicit decisions (especially exclusions), resource pressures are now rekindling interest in fixed provider budgets and implicit clinical decision making. The paper concludes by considering the implications for rationing of proposals to abolish the NHS internal market.     

Policy analysis as discourse

The field of policy analysis encompasses a greater diversity of practices than is commonly appreciated. Many recent revisions agree with the postmodern dictum that analytic studies are socially constructed and propose some form of discourse for formulating policy. This article compares three theoretical perspectives on discourse: analytic discourse, which draws on multiple theories and data sources; critical discourse, which emphasizes critical reflection and links evidence to value discussions; and persuasive discourse, which focuses on the role of ideas and persuasion by policy entrepreneurs. Analytic discourse has had the most impact on the practice of analysis, but the other two literatures have had some influence and address important issues. Critical discourse is sensitive to the structural biases in policy research, and persuasive discourse links the practice of analysis to opportunities in the policy arena. The author seeks to make us more conscious of alternative theories, while emphasizing the role of discourse in all three models and the linkages between policy design and the policy process.     

Risk Factors Associated with the Chronicity of High Potential for Child Abuse and Neglect

The present 4-year follow-up study involves 56 mothers who were evaluated by social agencies as being abusive and neglectful or at high risk for child abuse and neglect. The aim of the study is to analyze the relationship between psychosocial risk factors (relating to the history and current situation of the mothers) that were present at the time the families were initially recruited and the fact that some of the mothers continue to show a high potential for child abuse and neglect (chronic abuse and neglect), whereas others were able to overcome the problem (transitory abuse and neglect). Results indicate that the following variables are particularly associated with situations involving chronic problems of abuse and neglect: initial level of severity of potential for abuse and neglect; dual-parent status; a large number of children at the time of intervention (3.13 times more risk of chronicity for large families); the fact that as a child the mother herself had been placed in a foster home (3.7 times more risk); that she had been sexually abused (3.5 times more risk); and that as an adolescent she had run away from home (3.02 times more risk). Our results indicate that mothers who have a combination of more than eight risk factors are four times more likely to be in the chronic group.     

Women Offenders and the Gendered Effects of Public Policy1

At 17%, women represent a significant proportion of all offenders under criminal justice supervision in the US. Drawing on the findings from their report, “Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders,” the authors maintain that public policy has ignored the context of women's lives and that women offenders have disproportionately suffered from the impact of ill-informed public policy. This discussion of the implications of gender within the criminal justice system is based on a simple assumption: responding to the differences between women and men in criminal behavior and to their antecedents is critical to gender-responsive policy. Building on the pathway theoretical perspective, we find that in addition to the gendered impact of the war on drugs, policy changes in welfare reform, housing, and other social policy arenas combine to create a disparate impact on drug abusing women and women of color. Key policy areas affecting the lives of women offenders and their children include welfare benefits, drug treatment, housing, education, employment, and reunification with children. We conclude that addressing the realities of women's lives through gender-responsive policy and programs is fundamental to improved outcomes at all criminal justice phases. A blueprint for gender-responsive policy development is described through six guiding principles and their policy implications.     

The Emperor’s new clothes: Labor reform and social democratization in Chile

This article analyzes the relationship between political and social democratization in recent democratic transitions by illustrating how the two processes were at odds in the case of labor reform in Chile (1990–2001). Labor reform served simultaneously to consolidate political democracy and slow down the momentum of social democratization. It was a tool for signalling policy change to legitimate the democratic regime, but at the same time leaving the liberal economy intact. The Chilean case calls into question the thesis of a natural progression from political to social rights prevalent in democratic theory, and allows us to generalize about the way marketization places limits on democratic deepening. The article first discusses what would be appropriate criteria of social democratization considering contemporary labor issues and labor relations in Chile. It then investigates the political process of labor reform. Ongoing legal debates through the 1990s show the extent of path dependence set in motion by the timid nature of the first social reforms in Chile’s new demoncracy and their muting effect on citizenship. Louise Haagh obtained her doctorate from the University of Oxford (St. Antony’s College) in 1998, and for the next three years held a British Academy Postdoctoral Research Fellowship at the College. In 2001 she began a lectureship at the University of York.